Impact of deprescribing rounds on discharge prescriptions: an interventional trial
Background Successful deprescribing practices are required to address issues associated with polypharmacy but are hindered by minimal interprofessional collaboration, time constraints, concern for negative outcomes, and absence of a systematic and evidence-based approach. Objective Determine the impact of pharmacist-led deprescribing rounds within a clinical teaching unit (CTU) the number of home medications discontinued upon hospital discharge. Setting Canadian tertiary care hospital. Methods Prospective, dual-arm, interventional study conducted in a single centre, from November 23rd, 2015 to August 30th, 2016. All patients ≥ 19 years old admitted under the CTU were considered for enrolment if on medication(s) prior to admission and patients were excluded if not taking any medications. Study arm allocation alternated daily between the two teams. The control arm operated as per standard whereas the intervention arm’s pharmacist used a deprescribing guide and medication review to identify medications eligible for discontinuation prior to discussing during daily rounds. Discharge documents communicated medication changes to patient and primary healthcare providers. The study was sufficiently powered. Main outcome measure The difference of number of home medications discontinued at discharge between the intervention and control groups. Results 171 and 187 patients were allocated to the intervention and control arms, respectively. No significant differences of baseline characteristics existed between groups. Main outcome measure results showed that deprescribing rounds resulted in significantly more medications deprescribed compared to control (65% vs. 38%; p = 0.001). The rates of readmission and emergency department visits were reduced in the intervention arm. Conclusions Incorporating deprescribing rounds into routine care led to significantly greater discontinuation of medications without increasing rate of emergency department visits or hospital admissions.
Trial registration ISRCTN11751440
KeywordsCanada Clinical medication reviews Deprescribing Inappropriate medication use Interprofessional collaboration Patient care Pharmacist Polypharmacy
Conflicts of interest
Authors Rachel Edey, Nicholas Edwards, Jonah Von Sychowski, Ajay Bains, Jim Spence, and Dan Martinusen do not have any conflicts of interest to disclose or financial interests to declare.
- 1.(CIHI) CI for HI. Drivers of Prescription Drug Spending in Canada—drug_spend_drivers_en.pdf (Internet) (cited 2017 Mar 12). https://www.cihi.ca/en/drug_spend_drivers_en.pdf.
- 7.Thompson W, Farrell B. Deprescribing: what is it and what does the evidence tell us? Can J Hosp Pharm. 2013;66(3):201–2.Google Scholar
- 8.Farrell B, Tsang C, Raman-Wilms L, Irving H, Conklin J, Pottie K. What are priorities for deprescribing in elderly patients? capturing the voice of practitioners: a modified Delphi process. PLoS. 2015;10:1–16.Google Scholar
- 9.Masnoon N, Shakib S, Kalisch-Ellett L, Caughey GE. What is polypharmacy? a systematic review of definitions. BMC Geriatr (Internet). 2017 Oct 10 (cited 2018 May 27);17. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5635569/.
- 10.Page AT, Clifford RM, Potter K, Schwartz D, Etherton-Beer CD. The feasibility and effect of deprescribing in older adults on mortality and health: a systematic review and meta-analysis: effect of deprescribing in older adults on mortality and health. Br J Clin Pharmacol. 2016;82(3):583–623.CrossRefGoogle Scholar
- 13.Schuling J, Gebben H, Veehof LJG, Haaijer-Ruskamp FM. Deprescribing medication in very elderly patients with multimorbidity: the view of Dutch GPs. A qualitative study. BMC Fam Pract (Internet). 2012 Dec (cited 2016 Dec 18);13(1). http://bmcfampract.biomedcentral.com/articles/10.1186/1471-2296-13-56.
- 21.Harriman K, Howard L, McCracken L. Deprescribing medication for frail elderly patients in nursing homes: a survey of Vancouver family physicians. BCMJ. 2014;56(9):436–41.Google Scholar
- 23.Garfinkel D, Zur-Gil S, Ben-Israel J. The war against polypharmacy: a new cost-effective geriatric-palliative approach for improving drug therapy in disabled elderly people. Isr Med Assoc J. 2007;9(6):430–4.Google Scholar
- 24.Canadian Deprescribing Network (CaDeN) (Internet). Deprescribing.org. (cited 2016 Dec 19). http://deprescribing.org/caden/.
- 27.Alldred DP, Kennedy M-C, Hughes C, Chen TF, Miller P. Interventions to optimise prescribing for older people in care homes. In: The Cochrane Collaboration, editor. Cochrane database of systematic reviews (Internet). Chichester: Wiley; 2016 (cited 2016 Dec 19). http://doi.wiley.com/10.1002/14651858.CD009095.pub3.
- 31.Martin P, Tamblyn R, Ahmed S, Benedetti A, Tannenbaum C. A consumer-targeted, pharmacist-led, educational intervention to reduce inappropriate medication use in community older adults (D-PRESCRIBE trial): study protocol for a cluster randomized controlled trial. Trials (Internet). 2015 Dec (cited 2016 Dec 19);16(1). http://trialsjournal.biomedcentral.com/articles/10.1186/s13063-015-0791-1.